Cardiac disease in patients with reversible cerebral ischemic events

Investigation of the Transient Ischemia Workload and its Incidence: Implications for Occupational Therapy Research

With limited effectiveness of medical and surgical intervention following stroke, the focus has shifted to preventing stroke and the most important warning sign of an impending stroke, the Transient Ischemic Attack (TIA) or the “mini stroke.” We found that the incidence of hospital admissions for the TIA patients in a population of slightly more than 1 million (660,598 people 25 years and older) was 1.18 per 1,000 men, or a total of 386 men, and 0.73 per 1,000 women, or a total of 258 women. The overall admission rate was 0.95 per 1,000 people 25 and older. For those hospitalized, the mean age was 67.9 years for men, and 71.3 years for women. Our epidemiological study of hospital admissions and the cases reported and managed by the general medical practitioners in the community showed the crude incidence rate of 2.89 per 1,000 people 25 years and older, while the adjustment for the world standardized population rate yielded a value of 1.26 per 1,000, or 44% of the crude rate that was actually observed. There appeared to be a marked disparity between the reported female and male cases of TIA. The research discussion focuses on two equally important thrusts: 1) development of strategies to reduce identified risk factors for stroke, and 2) establishment of a premorbid patient profile by occupational therapists that will have widespread implications for identifying changes for the potential prevention and treatment of stroke.

Thromboembolism in patients with advanced mitral valve prolapse

Thromboembolism in mitral valve prolapse (MVP) has been suggested to occur in relation to valvular cul-de-sac recesses and endothelial wear-and-tear denudations. Such pathology would be suspected to be prominent in advanced cases of MVP necessitating open-heart operation. We therefore analysed the prevalence of perivalvular thrombi and episodes of systemic arterial embolism (SE) prior to operation in 21 consecutive patients with MVP and severe valve regurgitation. No perivalvular or left atrial thrombi were found during open-heart surgery, but three of the patients (14%, 3-36% with 95% confidence limits) experienced SE, in one case despite long-term anticoagulation. All cases of SE took place less than 3 months before operation. The results indicate that persistent thrombi are rare in MVP and severe valve regurgitation. However, such patients run a substantial risk of SE when they reach a clinical and haemodynamic stage that makes valve surgery mandatory.